Continuity in practice

Resource

Continuity helps care according to Isaac Barker et el in the BMJ Feb 2017. Higher continuity of care was associated with fewer admissions for ambulatory care sensitive conditions, particularly for the heaviest users of healthcare. 230 472 patients aged between 62 and 82 years and who experienced at least two contacts with a general practitioner between April 2011 and March 2013. The usual provider of care index, was defined as the proportion of contacts occurring that were with the most frequently seen general practitioner. Continuity of care has previously been associated with patient and practitioner satisfaction.
This can be read at: http://www.bmj.com/content/356/bmj.j84

Know the story
Build on from before
Use all sources of information

What are the fundamentals of continuity of care? Seeing the same person helps because it builds on a relationship and prior knowledge. There are situations where you cannot see the same person but steps can be taken to retain the advantages. Continuity of records, the nature of the records and how proactively they are handled by the person you are seeing are the key.

Know the story

Knowing the story provides the bedrock to start from. There are the current medical problems, past medical problems and how they were treated. This provides the essentials for good treatment but it is the social elements that make the difference between good care and high quality care. It is knowledge of the family, occupation and life events which allow a doctor to place the medical problems in context and deal with them more effectively. However, it is knowledge of the psychological elements that make the difference between high quality and excellent care. Knowing how a person relates to someone else and to illness tailors the diagnosis and management to that particular individual. This is the cutting edge of medical records which has not been effectively addressed. Myers Briggs personality scales are an example of how this might be recorded, but it is really only by seeing the same person again that his level of excellent care can be achieved.

Build on from before

Building on from where you were can only be done if you know all the story and background already. A ten minute consultation does not give enough time to get all the story to build on from. If the records (or your knowledge) give you the story in full then you can build on this point and really deal with the issues that present.

Use all sources of information

There are at least two minds working on the problem in every consultation and it helps to make the most of every mind in the room. People bring their own ideas and beliefs to the consultation. Often they have been thinking over the problem for a long time and have researched the cause with friends, relatives and the internet. It is crucial to identify these ideas because they can be a short cut to the diagnosis, provide a starting point for mutual understanding and allow time to address misunderstandings and false beliefs. Many times relatives, parents and patients have the correct diagnosis in their mind and doctors miss this at their peril